APPLICATION FOR RETIREMENT LEAVE OF ABSENCE …

New York City Department of Education - Division of Human Capital HR Connect

65 Court Street, Brooklyn, New York 11201

APPLICATION FOR RETIREMENT LEAVE OF ABSENCE (TERMINAL LEAVE)

SECTION I: To be completed by the applicant

FILE NUMBER

SOCIAL SECURITY # Last 4 Digits

LAST NAME STREET ADDRESS

FIRST NAME

M.I. APT.

CITY SCHOOL: DATES OF RETIREMENT LEAVE (Both dates inclusive)

DISTRICT:

STATE

Borough Office:

ZIP CODE

INITIAL DATE

TERMINAL DATE

I intend to retire on the first school day immediately following the terminal date of my retirement leave of absence (terminal leave).

I understand that any days of absence due to personal illness taken between the dates of application or date of application or date of approval of retirement leave and the starting date of the leave may reduce the length of retirement leave and that the Teachers' Retirement System will consider the period of my retirement leave as active duty for retirement purposes.

Signature of Applicant

Today's Date

SECTION II: To be completed by the Payroll Secretary and sign by the Principal

Note: Inform the Borough Office of any reduction in Cumulative Absence Reserve subsequent to date of this application that would reduce allowable period of leave.

Total number of days in Cumulative Absence Reserve

Total number of school days requested for this retirement leave of absence with pay (Terminal Leave)

Signature of Principal

Today's Date

EMAIL ADDRESS (PAYROLL SECRETARY):

@schools.

Application for Retirement Leave of Absence (Terminal Leave) - Formally OP 40 Page 1 of 2

RETIREMENT LEAVE OF ABSENCE (TERMINAL LEAVE) Rules Chancellor's Regulation (former By Law Section) 106.3a

Upon application in accordance with the rules enumerated below, absence from duty Retirement Leave of Absence (Terminal Leave) with full pay may be granted to a member of the teaching, supervising, or attendance staff under regular appointment, who is a member of the Teachers Retirement System and who will be eligible for service retirement upon completion of the leave. 1. A Terminal Leave shall be granted on the basis of one half of the accumulated unused sick leave (Cumulative Absence Reserve) up

to a maximum of one school term (five calendar months exclusive of July and August).

School term refers to either the Fall or Spring division of the school year as indicated below. To avoid disruption of the educational program, leave shall not extend from one school term into the next school term.

Fall Term (Both Dates Inclusive) Initial date: August (from the first day on which Applicant to report to duty) Terminal date: January (to the last school day of the semester)

Spring Term (Both Dates Inclusive) Initial date: February (from the first school day) Terminal date: June (to the last school day of the semester)

Vacation Periods When a vacation period intervenes between the end of a Terminal Leave and the member's Retirement Date such vacation period shall be deemed a period of active service for purposes including compensation.

2. A Terminal Leave shall be terminated when the member on such leave:

a) Applies to the Teacher's Retirement System for immediate retirement; b) Applies to the Borough Office for reinstatement to active service (except that such termination may not be granted during the last

month of the term in question; c) Applies to School Principal or other appropriate supervisor for Sick Leave (OP 198) and submits Confidential Medical Report (OP

407) which is approved by HR Connect.

3. A member who terminates Terminal Leave to apply for Sick Leave shall be entitled to the total Cumulative Absence Reserve minus the number of school days actually used during the period of Terminal Leave.

4. A member who terminates Terminal Leave shall be deemed to have forfeited the future right to the number of days of Terminal Leave already taken.

5. A substitute may be employed to replace any member on Terminal Leave.

6. Application for Terminal Leave shall be made to HR Connect at least one month prior to the initial date of requested leave (and for leaves beginning in August, at least one month prior to the commencement of the summer vacation period).

7. During Terminal Leave, no member may serve in any capacity under any New York City Department of Education school or office or in any publicly-supported institutions in New York City or State. The Conflicts of Interest Law applies to employees on paid or unpaid leaves of absences, so employees on leave must contact the Department of Education Ethics Officer for advice regarding outside activities, including but not limited to outside employment, and owning or operating a business, to determine whether a waiver from the New York City Conflict of Interest Board is needed.

8. Unforeseen closing of schools or other conditions which may excuse non-attendance of working personnel, occurring during the period of Terminal Leave, shall not change the total number of days originally computed for the Terminal Leave applied for or granted.

Instructions

Full instructions and guidelines are on the HR Connect Portal. Once you have logged in with your DOE User ID and Password, search for "Terminal Leave."

1. Please consult with your retirement system to set your date of retirement. 2. Complete the Application and please submit this form through the Upload Document feature of the HR Connect

Portal at . If you are a DOE employee, you will need to log in with your DOE username and password. Non-employees must create an account.

Application for Retirement Leave of Absence (Terminal Leave) - Formally OP 40 Page 2 of 2

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